Arthroscopic knee surgery can be challenging because there is no intuitive relationship between the arthroscopic image, shown on a screen above the patient, and the camera in the surgeon's hand. As a result, arthroscopic surgeons require extensive training and experience. This thesis describes a computer system to help improve target acquisition in arthroscopy by visualizing the location and alignment of an arthroscope using augmented virtuality. A 3D computer model of the patient's joint (from CT) is shown, along with a model of the tracked arthroscopic probe and the projection of the camera image onto the virtual joint. We performed a user study to determine the effectiveness of this navigated display; the study showed that for novice residents, the navigated display improved target acquisition. However, residents with at least two years of experience performed worse. For surgeons, no effect on performance was found. / Thesis (Master, Computing) -- Queen's University, 2010-11-25 23:29:46.526

Reflex inhibition of the quadriceps muscle group is a frequent and significant consequence of knee trauma, disease and surgical insult. The resultant quadriceps atrophy can be expected to delay rehabilitation and render the joint vulnerable to repeated injury resulting in capsular and synovial thickening, effusion and pain. A major purpose of this study was to examine the degree of quadriceps inhibition experienced by patients who undergo arthroscopic menisectomy. A secondary goal of this study was to investigate the efficacy of transcutaneous electrical nerve stimulation on the relief of reflex inhibition. Tests were performed on 12 patients prior to, and on day 1 and day 2 post surgery. True and placebo treatments of transcutaneous electrical nerve stimulation were administered on day 1 and day 2 post surgery. Measurements were made on the injured and normal limb with the knee fixed at 38G of flexion. Motor unit activation was determined by the twitch interpolation technique. Reduced motor unit activation was considered indicative of quadriceps reflex inhibition. Testing demonstrated that at all times the injured leg was weaker than the normal leg (p=.OOl). Following surgery, strength of the injured limb was significantly less than its pre operative score (p=.Ol). No significant recovery of strength was observed during the first two days following surgery. Injured legs were characterized by significantly lower motor unit activation at all times of testing Cp=.003). Following surgery, motor unit activation for the injured leg was significantly lower than its pre operative value (p=.Ol). By day 2 post surgery, motor unit activation had recovered Cp=.05) and was similar to the pre operative values for that leg. Transcutaneous electrical nerve stimulation had no effect on strength or motor unit activation. Recovery following arthroscopic surgery is characterized by an initial loss of strength and motor unit activation. By day 2, isometric strength remains depressed, however motor unit activation returns to pre surgery levels. / Thesis / Master of Science (MSc)

This research evaluated serum amyloid A (SAA) concentration in synovial fluid of healthy horses as a potential marker for use in the diagnosis and monitoring of horses with septic arthritis. The first study evaluated the effect of arthroscopic lavage of healthy joints on concentrations of systemic and synovial SAA; as well as total protein concentration, nucleated cell count and percentage of neutrophils in synovial fluid. The second study, evaluated the effect of repeated through-and-through joint lavage on SAA in systemic blood and SAA, total protein, nucleated cell count and percentage of neutrophils in synovial fluid from healthy joints. In the first study, middle carpal joints of 6 horses were randomly assigned to one of the following treatments 1) arthrocentesis (controls) or 2) arthroscopic lavage. A washout period of 30 days was allowed in between treatments. Synovial fluid and blood samples were collected at 0, 24, 48, 72, 96 and 120 h. Measurements included SAA in blood and synovial fluid, and total protein, nucleated cell count and percentages of neutrophils in synovial fluid. In the second study, one tarsocrural joint was randomly assigned to receive repeated through-and-through joint lavage at 0, 48 and 96 h in 6 horses. Synovial fluid and blood samples were collected at 0, 24, 48, 72, 96 and 120 h. Measurements included SAA in blood and synovial fluid, and total protein, nucleated cell count and percentages of neutrophils in synovial fluid. For this study, synovial fluid samples collected at time 0 were considered as control values. After arthroscopic lavage and repeated through-and-through joint lavage, systemic and synovial SAA did not increase from baseline values (except for systemic SAA at 24h after arthroscopic lavage and in controls). Total protein values were significantly increased at all time points after arthroscopic and through-and-through joint lavages (except at 96h on both lavage procedures) but not in controls. With both lavage procedures, nucleated cell count significantly increased from baseline values at all time points (except at 96h after through-and-through joint lavage). Percentage of neutrophils was significantly increased after arthroscopic lavage at all time points and only at 24h in controls; however, the percentages of neutrophils were not significantly increased after repeated through-and-through joint lavage. Synovial SAA was not affected by arthroscopic or repeated through-and-through joint lavage; however, synovial total protein and nucleated cell counts were significantly increased. Synovial SAA may be a valuable inflammatory marker that is not affected by procedures as arthroscopic or repeated through-and-through joint lavage in horses. Further validation of synovial SAA as a marker for evaluating the progression of septic joints while treatment is installed is warranted.

Title: PNF technique after arthroscopic stabilization of the shoulder joint Objectives: The objective of this work is to consider the possibility of use of the proprioceptive neuromuscular facilitation technique (PNF) in early stages of rehabilitation after arthroscopic stabilization of the shoulder joint. The idea is to use the phenomen of irradiation with which this concept works. Methods: The pilot experimental group consisted of 7 healthy participants with simulated arthroscopic stabilization of the left shoulder joint. The electromyography was used to record the electric activity of musculus trapezius pars descendens, pars transversa et pars ascendens, musculus deltoideus pars acromialis, musculus infraspinatus and musculus pectoralis major pars sternocostalis on the immobilized left arm; while using the PNF technique on the peripheral parts of the immobilised arm; and on the contra lateral arm. A 5s sequence of stabilised isometric contraction was analysed and all data further normalised to Maximal Voluntary Contraction (MVC). Considering the literature the 20% increase above the MVC was defined as substantial to assure sufficient functional capacity of the muscle fibres and therefore sufficient to stop muscle atrophy during immobilisation of the arm. Results: Results of this study support...

This Thesis presents a design innovation in arthroscopic forceps. Based on surveying the subject-matter literature on arthroscopic surgery of the knee, design changes are proposed to alter the cutting geometry of the functional end of the instrument to improve its utility. The proposed changes are imple-mented in a prototype, which is then compared with the current design. The comparison is made by testing the functioning of the instrument and the force required to shear the test material.

Current return-to-drive recommendations for patients following rotator cuff repair (RCR) surgery are not uniform due to a lack of empirical evidence relating driving safety and time-after-surgery. To address the limitations of previous work, Badger et al. (2022) evaluated, on public roads, the driving fitness of patients prior to RCR and at multiple post-operative timepoints. The goal of the Badger, et al. study was to make evidence-based return-to-drive recommendations in an environment with higher fidelity than that of a simulator and not subject to biases inherent to surveys. Badger et al., however, do not fully investigate the driving practices exhibited by subjects, overlooking the potential presence of compensatory driver behaviors. Further investigation of these behaviors through observation of direct driving techniques and practices over time can specifically answer how drivers may modify their behaviors to address a perceived state of impairment. Additionally, the degree of success in vehicle operation by comparing an ideal turn to the path taken by the driver allows for a level of quantification of the effectiveness of the compensatory techniques. Moreover, driver trajectories inferred from the vehicle Controller Area Network (CAN) metrics and from global positioning system (GPS) coordinates are contrasted with the ideal turn to assess minimum requirements for future sensors that are used to make these trajectory comparisons. This investigation leverages pre-existing data collected by the Virginia Tech Transportation Institute (VTTI) and Carilion Clinic as used in the analysis performed by Badger et al. (2022). RCR patients (n=27) executed the same prescribed driving maneuvers and drove the same route in a preoperative state and at 2-, 4-, 6-, and 12-weeks post operation. Behavioral data were annotated to extract key characteristics of interest and related them to relevant vehicle sensor readings. To construct vehicle paths, data was obtained from the on-board data acquisition system (DAS). Behavioral metrics considered the use of ipsilateral vehicle controls, performance of non-primary vehicle tasks, and steering techniques utilized to assess the impact of mobility restrictions due to sling use. Sling use was found to be a significant factor in use of the non-ipsilateral hand associated with the operative extremity (i.e., operative hand) on vehicle functions and, in particular, difficulty with the gear shifting control. Additionally, when considering the performance of non-primary vehicle tasks as assessed through a prescribed visor manipulation, sling use was not a significant factor for the task duration or completion of the task in a fluid motion. Sling use was, however, significant with respect to operative hand position prior to the completion of the visor manipulation: the operative hand was often not on the steering wheel prior to the visor maneuver. In addition, the operative hand was never used to manipulate the visor when the sling was worn. One-handed steering was also more frequent with the presence of the sling. Further behavioral analysis assessed the presence of compensatory behavior exhibited by subjects during periods in which impairment was perceived. Perceived impairment was observed as a function of the different experimental timepoints. Findings indicated a significant decrease in the lateral vehicle jerk during post-operative weeks 6 and 12. Significant differences, however, were not observed in body position alteration to avoid contact with the interior vehicle cabin, in over-the-shoulder checks, and in forward leans during yield and merge maneuvers. Regarding trajectory analysis, sling use did not produce a significant difference in the error metrics between the actual and ideal paths. In completion of turning maneuvers, however, operative extremity was significant for left turns, with greater error against the ideal path observed from those in the left operative cohort compared to those in the right operative cohort. For the right turn, however, operative extremity was not found to be a significant factor. In addition, the GPS data accuracy proved insufficient to support comparison against the ideal path. Overall, findings from this study provide metrics beyond those used in Badger, et al. that can be used in answering when it is safe for rotator cuff repair patients to return-to-drive. With the limited differences observed as a function of study timepoint and sling use, it is recommended that patients are able to safely return-to-drive at two weeks post-operation. If anything, results suggest that overcompensation, as inferred from observation of safer driving behaviors than normal, is present during some experimental timepoints, particularly post-operative week 2. / Master of Science / Current recommendations based on when it is safe for rotator cuff repair patients to return-to-drive are not standard because of a lack of suitable evidence. Previous work and recommendations rely on surveys and simulators which do not create fully realistic conditions and are subject to biases. To address the limitations of previous work, Badger et. al (2022) studied actual rotator cuff repair patients on public roads prior and following operation at multiple timepoints. Badger et al., however, did not consider the potential adaptations in driver behavior due to mobility restrictions and the perception of inferiority due to injury. Additionally, the degree of success of the adaptive driving behaviors based on the error between the actual vehicle path taken and a defined ideal path have not been explored in conjunction with the injury. This investigation is based on the pre-existing data collected by the Virginia Tech Transportation Institute (VTTI) and Carilion Clinic as used in the analysis performed by Badger et al. (2022). RCR patients (n=27) executed identical driving maneuvers and drove the same route before operation and at 2-, 4-, 6-, and 12-weeks post operation. Behavioral observations were recorded and related to relevant vehicle sensor readings. To construct vehicle paths, data was taken from the on-board data acquisition system (DAS). Participants adopted different behaviors, such as using the right hand to use the turn signal when the left arm was in a sling and the left hand to operate the gear shifter when the right arm was on a sling, to assist in combating mobility restrictions. One-handed steering was also more prominent during periods of sling-use. Sling-use, however, did not produce a significant difference in error between the actual vehicle path taken and the ideal path available to the driver. For left-operated participants completing left turns, there was also greater error in comparison to the ideal path than for the group of right-operated patients. However, there was not a difference between left- and right-operated arm participant error in completion of a right turn. The GPS data did not provide a suitable approximation of vehicle trajectory. Overall, findings from this study help to answer when it is safe for rotator cuff repair patients to return-to-drive through evaluation of the effectiveness of compensatory behaviors adopted by participants. With no significant difference in turn execution based on sling use, results suggest that patients can safely return-to-drive at two weeks post-operation. In fact, results suggest that overcompensation towards safer behaviors is present during some experimental timepoints, particularly post-operative week 2.

<p>Minimally invasive operations have gained popularity over open surgical procedures in the recent years. These procedures, require the surgeon to perform highly specialized tasks including manipulation of tools through small incisions on the surface of the skin while looking at the images that are displayed on a screen. Therefore, effective training is required for the surgeons prior to performing such procedures on patients.</p> <p>In this thesis I explored a novel idea for creating a training system for arthroscopic surgery. Previously obtained CT images of a patient model and the surgical tools are manipulated to create a library of fluoroscopy images. The surgical tools are tracked (a mechanical tracker and an electromagnetic tracker used in each iterations) in order to generate a spacial relationship between the patient model and the surgical tools. The position and orientation information from the tracking system is translated into the image coordinate frame. These homologous points in the two images (of surgical tools and the patient model), are used to co-register and overlay the two images and create a virtual fluoroscopy image.</p> <p>The output image and the system performance was found to be very good and quite similar to that of a fluoroscopy system. The registration accuracy was evaluated using Root Mean Square Target Registration Error (RMS TRE). The RMS TRE for the system setup with the mechanical tracker was evaluated at 2:0 mm, 2:1 mm, and 2:5 mm, for 4, 5, and 6 control points, respectively. In the system setup with the electromagnetic tracking system the RMS TRE was evaluated at 7:6 mm, 12:4 mm, and 11:3 mm, for 5, 7, and 9 control points, respectively. The acceptable range of error for arthroscopy procedures has been proposed to be 1-2 mm.</p> <p>It was concluded that by using a tracking system, which is not prone to interference and allows for a wide range of motion this system can be completed to the point of manufacturing and use in training new surgeons.</p> / Master of Applied Science (MASc)

Introduction: Arthroscopic partial resection of degenerative meniscal injuries has previously been frequently performed but has been questioned in recent years. However, contradictory data exist. Aim: We aimed to asses patient- reported outcome in patients over 40 years of age after arthroscopic surgery due to degenerative meniscal injury. We further aimed to compare women and men due to diagnosis and to examine the number of patients that have needed knee arthroplasty during the follow-up period. Methods: Patients &gt; 40 years of age who underwent arthroscopic surgery of the knee in the years of 2011-2013 were studied using validated questionnaire KOOS (Knee Injury and Osteoarthritis Outcome Score) along with a self-constructed questionnaire. Results: In all subjects, the highest median score was seen in all daily living (Women:93, Men: 96) and knee pain (Women: 86, Men: 92). The lowest score was seen in sports and recreation (Women: 55, Men: 65). Men had an overall higher KOOS-score in every subscale compared to women (p&gt;0.05). No significant difference was seen between women and men divided by diagnosis (p&gt;0.05). 72% women and 80% men experienced improved knee function today compared to before surgery. 22% women and 14% men experienced deterioration in knee function. 6% women and men experienced unaltered knee function. 24 patients (9.5%) had got a knee arthroplasty. Conclusions: This study showed that most middle-age patients experienced increased knee function and high satisfaction rate after partial meniscectomy when suffering from degenerative meniscal injury.

Author: Anna Reiterová Title: Early rehabilitation in comparison with the traditional approach after arthroscopic surgery of the rotator cuff - literature research Aim: To process a literature search concerning the reconstruction of the rotator cuff with regard to early physiotherapy, its safety and effectiveness.To map the approach to the issue from the point of view of surgeons in the form of a non-standardized questionnaire survey. To compile a systematic review of studies comparing early and delayed physiotherapy in the form of passive movements. Backgroung: The primary goals in the postoperative period after rotator cuff repair are to minimize pain, protect the repaired muscle and tendon, and finally restore shoulder function. At a time when the gold standard was open access, surgeons recommended an early passive range of motion after repairing the rotator cuff in an effort to reduce the likelihood of the formation of adhesions leading to stiffness of the operated arm. Although early passive movement may minimize the chance of a stiff arm, it may not be optimal for the early stages of rotator cuff healing. Metoda: thesis is processed in the form of literary research. Literary sources of the work were searched in the databases PubMed, MEDLINE, PEDro, Web of Science, EBSCOhost and Scopus. The...

La chirurgie arthroscopique présente actuellement un essor très important pour le bénéfice du plus grand nombre des patients. Cependant, cette technique possède un certain nombre d'inconvénients et il est donc nécessaire pour le médecin de s'entrainer et répéter ses gestes afin de pouvoir exécuter ce type d'opération d'une façon efficace et certaine. En effet, les méthodes traditionnelles d'enseignement de la chirurgie sont basées sur l'autopsie des cadavres et l'entrainement sur des animaux. Avec l'évolution de notre société, ces deux pratiques deviennent de plus en plus critiquées et font l'objet de réglementations très restrictives. Afin d'atteindre un niveau plus élevé, de nouveaux moyens d'apprentissage sont nécessaires pour les chirurgiens. Récemment, la réalité virtuelle commence d'être de plus en plus utilisée dans la médecine et surtout la chirurgie. Les simulateurs chirurgicaux sont devenus une des matières les plus récentes dans la recherche de la réalité virtuelle. Ils sont également devenus une méthode de formation et un outil d'entrainement valable pour les chirurgiens aussi bien que les étudiants en médecine. Dans ce travail, un simulateur de réalité virtuelle pour l'enseignement de la chirurgie arthroscopique, surtout la chirurgie du poignet, a été préesenté. Deux questions principales sont abordées : la reconstruction et l'interaction 3-D. Une séquence d'images CT a été traitée afin de générer un modèle 3-D du poignet. Les deux principales composantes de l'interface du système sont illustrées : l'interaction 3-D pour guider les instruments chirurgicaux et l'interface de l'utilisateur pour le retour d'effort. Dans ce contexte, les algorithmes qui modélisent les objets en utilisant les approches de "Convex Hull" et qui simulent la détection de collision entre les objets virtuels en temps réel, sont présentés. En outre, un dispositif de retour d'effort est utilisé comme une interface haptique avec le système. Cela conduit au développement d'un système à faible coût, avec les mêmes avantages que les appareils professionnels. A cet égard, l'arthroscopie du poignet peut être simulée et les étudiants en médecine peuvent facilement utiliser le système et peuvent apprendre les compétences de base requises en sécurité, flexibilité et moindre coût